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NPI Code Detail

MEDICARE: MARY G LOCKWOOD SLP

MEDICARE: MARY G LOCKWOOD SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist242004834IL

General Provider Information

NPI Number : 1871061622
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY G LOCKWOOD SLP
Provider Business Mailing Address
First Line : 644 W WRIGHTWOOD AVE APT 9
Second Line :
City : CHICAGO
State : IL
Zip : 60614-2593
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3800 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3606
Country : US
Telephone Number : 773-478-4222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2018
Last Update Date : 11/09/2018

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Directions to “ MARY G LOCKWOOD SLP” Practice Location

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